title: Successful reconstruction for complex malunions and nonunions of the tibia and femur.
abstract: BACKGROUND
  Information regarding the long-term outcomes of the treatment of lower-extremity fracture malunion and nonunion is lacking.
  
  
  METHODS
  Twenty-nine secondarily referred patients with complex malunion or nonunion of the tibia or femur, treated by a single surgeon, were followed for a median of twenty years (range, twelve to thirty-five years) after injury. The patients were referred at a median of twenty months (range, 1.5 to 360 months) postinjury and had undergone a median of three prior surgical procedures (range, zero to twenty-eight). At the time of final follow-up, patient-based outcomes, patient satisfaction, and pain were evaluated.
  
  
  RESULTS
  All twenty-nine patients had healing following treatment of the complex malunion or nonunion of the tibia or femur and were able to bear full weight and walk one block or more. The Lower Extremity Functional Scale (LEFS) outcome tool revealed that twenty patients (69%) experienced moderate-to-severe difficulties in carrying out activities because of their lower-limb disability. The median Short Form-36 (SF-36) score was 67, with a median physical component score of 61 and a median mental component score of 71, indicating substantial impact on physical health status when compared with the norm.
  
  
  CONCLUSIONS
  Reconstruction can be a worthwhile endeavor and should be considered for all patients with complex malunion or nonunion of the tibia or femur.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA. gbuijze@partners.org
authors.forename: Geert A
authors.initials: GA
authors.lastname: Buijze
authors.forename: Shawn
authors.initials: S
authors.lastname: Richardson
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Jupiter
mesh_terms: D000328:Adult; D005260:Female; D005264:Femoral Fractures / Q000534:rehabilitation / Q000601:surgery*; D005269:Femur / Q000601:surgery; D017759:Fractures, Malunited / Q000534:rehabilitation / Q000601:surgery*; D005599:Fractures, Ununited / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000534:rehabilitation; D019651:Plastic Surgery Procedures / Q000534:rehabilitation; D020127:Recovery of Function; D013977:Tibia / Q000601:surgery; D013978:Tibial Fractures / Q000534:rehabilitation / Q000601:surgery*